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SB 974

Insurance: health insurers; updated references to reflect the enactment of the Michigan health insurance exchange act; provide for. Amends secs. 1261, 1262, 1262a & 1264 of 1956 PA 218 (MCL 500.1261 et seq.). TIE BAR WITH: SB 0973'26

2025-2026 Regular Session Introduced by Darrin Camilleri and 9 co-sponsors

Michigan SB 974 updates rules for health insurance navigators and certified application counselors to ensure proper certification, funding, activities, and privacy protections with

referred to Committee on Insurance
#insurance:exchanges #insurance:healthinsurers
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Bill Summary · SB 974

Overview

  • Bill: Senate Bill 974 (SB 974)
  • Session: 2025-2026
  • Jurisdiction: Michigan
  • Purpose: Amend the Insurance Code of 1956 to update references related to the Michigan health insurance exchange act and to address the roles and activities of navigators and certified application counselors within the health insurance exchange system.
  • Tie-bar: Linked to SB 973 of the same session (SB 973)

What the bill does (main purpose)

  • Updates and clarifies definitions and duties related to the administration of health insurance navigators and certified application counselors (CACs) in Michigan’s health insurance exchange framework.
  • Aligns state law with federal provisions under the Affordable Care Act (ACA) and the Michigan health insurance exchange act.
  • Sets out certification, funding, permissible activities, conflicts-of-interest disclosures, and the director’s enforcement authority for navigators and CACs.
  • Establishes privacy, security, training, and reporting requirements to protect residents’ information.

Key provisions and changes

  • Definitions (Sec. 1261)

    • Clarifies terms such as:
    • Navigator, Certified Application Counselor (CAC), and certificate holders
    • What constitutes “exchange,” “qualified health plan,” “insurance,” and related activities
    • Distinguishes roles: navigators vs CACs, and their respective authorities and limitations
    • Aligns terminology with ACA and Michigan’s exchange act

  • Navigators (Sec. 1262)

    • Eligibility to act as a navigator requires certification by the state and an application under 1263(1)
    • Funding eligibility: navigators must be certified to receive funding from an exchange
    • Authorized duties (subject to ACA):
    • Public education about qualified health plans (QHPs)
    • Distribute neutral information on enrollment, premium tax credits (IRC 36B), and cost-sharing reductions (ACA)
    • Facilitate QHP selection
    • Refer enrollees with grievances or questions to appropriate state agencies
    • Provide culturally and linguistically appropriate information
    • Prohibited activities:
    • Selling, soliciting, or negotiating health insurance
    • Recommending specific health benefit plans or policies
    • Providing information/services beyond health benefit plans or exchange-associated products
    • Privacy and security: the director may require privacy protections; may implement a program including:
    • Criminal history checks (ICHAT)
    • Training on privacy, ethics, ACA provisions, and state-specific needs
    • Disclosure and reporting: applicants must disclose potential conflicts of interest; annual reporting to Senate/House committees on any federal program impacts and department changes

  • Certified Application Counselors (CACs) (Sec. 1262a)

    • Eligibility requires certification via 1263(2) and state certification
    • Funding eligibility: CACs must be certified to receive exchange funding
    • Authorized duties (subject to ACA):
    • Public education on QHPs
    • Provide neutral information on all QHPs and available premium tax credits and cost-sharing reductions
    • Assist individuals with applying for coverage
    • Facilitate enrollment and plan selection
    • Provide culturally and linguistically appropriate information
    • Refer individuals with limited English proficiency to navigators or other assistance
    • Prohibited activities:
    • Selling, soliciting, or negotiating health insurance
    • Recommending a specific QHP or health insurance policy
    • Providing non-QHP regulated insurance information/services outside the exchange
    • Conflict of interest: CACs must disclose any potential conflicts of interest before providing services

  • Director’s enforcement and certification actions (Sec. 1264)

    • The director may place certificates on probation, suspend, revoke, or impose civil fines, and may refuse to issue certificates for grounds analogous to those for insurance producers
    • Prohibits improper compensation: the director may revoke or deny certificates if a person receives financial compensation (including gifts or in-kind support) from insurers offering QHPs through an exchange
    • Business entity accountability: a business entity certificate can be suspended or revoked if violations by one or more certificate holders were known or should have been known by leadership and not reported or remedied
    • Examination authority: the director may inspect the books and records of certificate holders to ensure compliance

  • Enacting provision

    • The act’s effective date is contingent on the enactment of SB 973 (a tie-bar to SB 973)

Who is affected

  • Navigators and CACs operating within Michigan’s health insurance exchange framework
  • Individuals seeking to enroll in QHPs through the Michigan exchange
  • Insurance producers and insurers offering QHPs through the exchange
  • State health policy oversight bodies and committees (Senate and House health policy committees)
  • Employers and business entities acting as navigators or CACs (to the extent they employ or designate individuals)

Procedural and timeline aspects

  • Certification and funding:
    • Navigators CACs must be certified by the state to act and to receive exchange funding
  • Training and privacy:
    • Programs may require privacy/security training, criminal history checks (ICHAT), and other state-specific training
  • Reporting:
    • The director must submit annual reports to Senate and House standing committees detailing federal program assessments, changes, and implementations
  • Effective date:
    • The act contains an enacting clause stating it takes effect only if SB 973 becomes law (tie-bar provision)

Potential impacts

  • Strengthened regulatory oversight of navigators and CACs, including conflict-of-interest disclosures and funding controls
  • Greater alignment between Michigan state law and federal ACA provisions related to the exchange
  • Enhanced privacy and security safeguards for individuals applying for or enrolled in health coverage
  • Clear delineation of permissible activities to prevent conflicts with insurance sales and plan recommendations
  • Potentially smoother enrollment processes and more consistent information dissemination about premium tax credits and cost-sharing reductions

If you would like, I can provide a side-by-side comparison with current law or a quick FAQ for readers seeking practical answers.

Compiled from official sources — confirm details with the bill’s official record.

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